Outcome of very low birthweight neonates in a developing country: experience from a large Malaysian maternity hospital.

MedLine Citation:

PMID:
1598605
Owner:
NLM
Status:
MEDLINE

Abstract/OtherAbstract:

Between January 1989 to April 1990 (16 months), a prospective observational study was carried out on 329 consecutive very low birthweight (VLBW) less than or equal to 1500 grams) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur before their first discharge from the hospital. The objectives of the study were to determine the common causes of early morbidity and mortality of this group of Malaysian neonates. The study shows that the incidence of Malaysian VLBW neonates was 9.9 per 1000 livebirths (95% confidence intervals 9.0 to 10.8). The mean duration of stay in the hospital was 19.3 days (SD = 21.4). One hundred and ninety-six (59.6 percent) of the VLBW neonates died. They accounted for 60 percent (196/334) of all neonatal deaths in the hospital during the study period. Mortality was significantly higher in neonates of birthweight less than 1000 grams (p less than 0.01) and of gestation of less than 33 weeks (p less than 0.001). The three most common clinical problems were respiratory distress syndrome (RDS) (72.6 percent), septicemia (28.0 percent) and intraventricular haemorrhage (IVH) (21.9 percent). Death occurred in 71.1 percent of the septicemic patients. The most common causative organisms of septicemia were multiresistant klebsiella (52.3 percent) and multiresistant acinetobacter (14.7 percent). RDS (33.2 percent), septicemia (29.6%) and IVH (17.9 percent) were the three most common causes of death. Improvement in the nursing staff situation and basic neonatal care facilities in this hospital and prevention of premature delivery could help to decrease morbidity and mortality in this group of neonates.Data on 329 consecutive very low birth weight (VLBW) (=or 1500 g) neonates born at the Kuala Lumpur Maternity Hospital in Malaysia were analyzed between January 1989 and April 1990 to determine causes of morbidity and mortality so the hospital could pinpoint priority areas to improve outcome in the time period before the hospital would actually upgrade its facilities. 95.7% of these newborns were born prematurely. The incidence of VLBW newborns was 9.9/1000 live births. The stay in the hospital after birth ranged from 1-127 days (mean 19.3 days). The mortality rate for the VLBW neonates was 59.6% (196). VLBW deaths made up 60% of all neonatal deaths in this hospital. Mortality risk factors included a birth weight of at most 1000 g (p .001) and gestational age less than 33 weeks (p .01). The 3 most frequent causes of death of the VLBW neonates included respiratory distress syndrome (33.2%), septicemia (29.6%), and intraventricular hemorrhage (17.9%). 67% of the VLBW infants with septicemia acquired the infection through poor hospital practices, as indicated by the fact that the most common pathogens were multiresistant Klebsiella (52.3%) and multiresistant Acinetobacter (14.7%). Overcrowding of the special care nursery and shortage of nurses contributed to these suboptimal practices. Further, 71,1% of the VLBW newborns with septicemia died and most of them (89.1%) weighed more than 1000 g at birth. These results indicated the need for this hospital to take steps to improve the staffing situation and to provide an adequate number of incubators and ventilators.